BENSALEM, Pa.--(BUSINESS WIRE)--The percentage of drugs with prior authorization (PA) on at least one
Commercial formulary has increased nearly 20 percent over the past nine
years, impacting product performance and patient access, according to
BusinessOne Technologies. From year end 2005 to November 2013, the
percentage of Commercial formulary drugs with prior authorization
increased from 61 percent to 80 percent. Formulary listings include
brand-name drugs, generic drugs, blood glucose monitors, and test strips.

“The managed care landscape is becoming more complex to navigate,
particularly with the increase in specialty pharmaceuticals, more
competition and, as a result, more restrictions for access,” said James
A. Barone, BusinessOne Technologies president and CEO. “We’ve seen a
consistent increase in the use of prior authorization as a leading
utilization management strategy. Payers will likely continue to increase
the use of prior authorization across drug categories, and we are seeing
the highest impact in the specialty category.”

Prior authorization is a clinical review designed to regulate the type
of drug patients can receive under insurance coverage. These trends are
driven by:

Growing competition across therapeutic categories, including oncology

Cost trends

The need to ensure appropriate use

Utilization drivers such as expanded indications, combination use, and
new oral/self-injectable formulations

Therapeutic breakthroughs that require biomarker matching

Contracting opportunities with manufacturers for preferred status

Complex coverage policy requirements

An evolving focus on outcomes and pay-for-performance

Greater specialty drug alignment between the pharmacy and medical
benefits

“With the right information, key stakeholders navigating this
increasingly complex managed care landscape can ensure that patients are
getting appropriate access to the medications they need,” Barone said.